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The external exposome encompasses several exposures that influence the developing immune system and modify food allergy risk. Environmental exposure to food allergens in household dust is increasingly recognized as a risk factor for sensitization, whereas early oral introduction promotes tolerance. Early\u2010life microbial exposures, especially those associated with rural and farming environments, may protect against food allergies by stimulating innate immune pathways and shaping the gut microbiome. Co\u2010exposures to microbial adjuvants can further alter risk in a timing\u2010dependent manner. Epidemiological birth cohort studies have linked exposure to air pollutants, such as particulate matter and nitrogen dioxide, to food sensitization and allergy. Synthetic chemicals represent an emerging risk factor by disrupting epithelial barrier integrity and immune regulation. Ultra\u2010processed food consumption and dietary additives may further increase risk by altering gut permeability and immune function. Significant gaps remain in our understanding of the most relevant environmental exposures affecting food allergy risk. Future research using longitudinal cohort designs and exposome\u2010wide approaches is essential for developing evidence\u2010based strategies to prevent food allergy.<\/jats:p>","DOI":"10.1111\/all.70501","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T08:58:46Z","timestamp":1788166726000},"page":"3472-3487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The External Exposome and Food Allergy: How Environmental Exposures Shape Disease Risk"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-3852","authenticated-orcid":false,"given":"Johanna M.","family":"Smeekens","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of North Carolina School of Medicine  Chapel Hill North Carolina 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